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Virginia rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Facilitymedian $2,754 · 10th–90th $1,738$10,0000%10%10th90th$2,754Professionalmedian $2,291 · 10th–90th $1,698$4,1690%10%10th90th$2,291$1.0K$2.0K$5.0K$10.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,187.76 / $3,019.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,187.76 / $3,467.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,606.93 / $7,413.10 / $9,332.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,511.89 / $4,265.80
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,454.71 / $4,365.16
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,818.38 / $4,570.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,691.53 / $3,162.28
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,467.37 / $4,365.16 / $4,897.79
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,754.23 / $4,265.80
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,388.44 / $3,388.44 / $3,388.44
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,630.27 / $9,549.93
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,090.30 / $10,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,456.54 / $10,471.29 / $21,379.62
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,691.53 / $4,265.80